Suctioning with mec at delivery

Thought I would post this here, because NICU nurses are THE BEST and always know "the answer".

I'm a new midwife. When I did my integration, the Chief of Pediatrics told me that the NRP guidelines re: Mec were changing, and unless I had particulate mec, I was NOT to do any cath suction on the perineum prior to delivery.

Where I work, babies with any mec other than "light" are routinely suctioned by the MD/CNM prior to birth of the shoulders.

New NRP changes are coming and I haven't heard what they are , but currently if you read the changes from 2000 (http://www.aap.org/nrp/pdf/nrp_oct00.pdf), they switched from intubating based on the type of meconium to whether or not the baby was vigorous. That being said, I do not believe NRP specifically elaborates on suctioning on the perineum since that is before we get a hold of the baby. Where I work, the doctors still suction on the perineum if there is meconium, but that does not determine what we do. I can tell you we intubate much fewer patients than in the past for meconium. Hope this helps somewhat. Good luck in your midwifery!!

Nov 26, '05

I heard that the new guidelines (in the next new NRP book) do away with DeLeeing on the perineum in mec deliveries. I don't know whether this is true or not.

We are supposed visualize the cords etc. before a baby is stimulated. Unfortunately, most of our ob's use a bulb syringe as soon as the baby is out, and don't get the kid to the warmer for us to do our job before the baby cries. Sometimes I want to take the bulb syringe away from the delivery table before the ob gets his/her hands on it. I think I irritated the ob at a c/s recently when I told the OR tech that he would not need the bulb syringe, but he did hear me and didn't use it.

Because of this, I can see more problems if we don't continue to DeLee on the perineum.

mimi

Nov 27, '05

hey guys, been teaching NRP for a few years, the answer is to suction on the perineum and if the baby is not vigorous, we then intubate and suction below the cords. Vigorous means active, breathing with good tone and heart rate. Hope this helps.

Nov 27, '05

That's what we do pooh.

Dec 1, '05

Hey all, just recieved the new guidelines (2006) from NRP, they are no longer recommending suctioning on the perineum, they say that the evidence doesn't show any benefits. Argh! An old dog having to learn new tricks! :chuckle

Dec 1, '05

Now we'll have to stand at the foot of the bed slapping the bulb suction out of the OB's hand.